Bullying takes a toll long after childhood

Those who both were bullied and acted as bullies show greatest risk of psychological disorders

February 27, 2013

“Having to keep the secret that you’re bullied and not having anyone to turn to for advice and support makes it that much harder," says Dr. Mark Schuster, chief of general pediatrics at Boston Children’s Hospital and a professor at Harvard Medical School. (Chris Price, E )

Kids who were bullied and acted as bullies themselves were at higher risk for depression, anxiety and panic disorder years down the line, according to a new study.

Researchers have known that bullying can take a psychological toll on both bullies and victims, but it's been unclear just how long those effects would last.

In the new study, depression and anxiety tied to bullying at school persisted at least through people's mid-20s. Worst off were those who had been both bullies and targets of bullying, according to findings published in JAMA Psychiatry.

"It's obviously very well-established how problematic bullying is short-term," said William Copeland, a clinical psychologist who led the new study at Duke University Medical Center in Durham, N.C.

"I was surprised that a decade down the road after they've been victimized, when they've kind of transitioned to adulthood, we would still see these emotional marks for the victims and also the bullies/victims."(bullies/victims cq per study)

His team's research included 1,420 youths from western North Carolina who were asked about their experiences with bullying at various points between ages 9 and 16, then were followed and assessed for psychiatric disorders through age 26.

Just over one-quarter of kids and their parents reported they were bullied at least once, and close to one in 10 said they had bullied other kids.

After adjusting for the participants' history of family hardships, the researchers found that, compared to young adults with no history of bullying, former victims were at higher risk for a range of psychiatric conditions.

For example, 6 percent of uninvolved youth went on to have an anxiety disorder, versus 24 percent of former bullying victims and 32 percent of youth who had been both bullies and targets of bullying.

Kids who originally reported both bullying and being bullied were the most likely to be diagnosed with panic disorder or depression as young adults or to consider suicide.

"It's not surprising that that would be the case, because in part they're reacting to the trauma of being bullied and they also carry with them the experience of having bullied," said Dr. Mark Schuster, chief of general pediatrics at Boston Children's Hospital and a professor at Harvard Medical School, who wasn't involved in the new research.

"These folks are the ones who get bullied and instead of experiencing empathy … they're more reactive and they see bullying as more of a way of getting attention," Copeland said.

Youth who were just bullies and never picked-on themselves were at four times higher risk for antisocial personality disorder, which is characterized by a lack of empathy and mistreatment of others.

Psychiatric disorders in childhood and kids' family problems were tied to bullying but didn't fully explain future problems, Copeland and his colleagues found. Some of the adult disorders seemed to stem from the bullying itself, they said.

The study "calls attention to just how serious bullying can be, and it reinforces what we've been learning, which is that bullying is not just a rite of passage, it's not just part of growing up and all kids experience it and they're stronger for it," Schuster said. "From everything we understand at this point, it can have serious long-term consequences."

Researchers said schools, parents and doctors need to work together to try to prevent bullying in the first place.

But for kids who have experienced bullying, Schuster said a supportive adult can go a long way toward preventing future psychological consequences.

"In part, they need an adult who can help them navigate this, who can help put an end to the bullying and can create a safe haven for them," he said. "Having to keep the secret that you're bullied and not having anyone to turn to for advice and support makes it that much harder."

Off-label chemo

About one-third of chemotherapies are used to fight cancers that drug regulators never approved them to treat, according to a new study.

Chemotherapies — drugs that kill rapidly dividing cells — are approved by the U.S. Food and Drug Administration to fight specific cancers, but there's nothing stopping doctors from prescribing the drugs "off-label" to treat other types of tumors.

Some researchers have questioned whether doctors were prescribing the expensive and toxic drugs outside of their intended use, according to the study's researchers, led by Rena Conti, an assistant professor of health policy and economics at the University of Chicago.

"The main criticism of off-label prescribing has been the concern that it jeopardizes patient safety because the full risk-benefit ratio is often not completely understood," wrote the University of Toronto's Dr. Monika Krzyzanowska, who published an editorial accompanying the study in the Journal of Clinical Oncology on Tuesday.